Social care reform was to be a priority during the second session of this parliament. In its first reforming months the coalition suggested that the Law Commission and Andrew Dilnot would produce reports during the first session that would form the basis of a new legal and financial framework for social care, and this would be the subject of legislation during the second session. But there is no such bill in the Queen's speech. Real life has intervened.

It isn't that there is no need for reform. Far from it. There has been a steady flow of evidence demonstrating that the present system isn't working – most recently in the form of an open letter from 78 interested organisations.

The problem lies in defining the purpose of reform. Supporters of the open letter argue that taxpayer funds should be made available to limit the care costs borne by families with savings. At the same time the Centre for Social Justice points to the inconvenient truth that this approach does not target resources on those in greatest need.

The problem is that both sides are arguing for a short-term fix, which will use taxpayer resources to allow the present system to stagger through another funding crisis without addressing its fundamental weaknesses.

It is certainly true that some short-term relief is necessary if NHS hospitals are not to be overwhelmed by an increasing flow of avoidable admissions, which they are later unable to discharge due to the inadequacy of social care provision. This depressingly familiar outcome manages to combine both high costs and low quality; it is unaffordably bad. Short-term relief is not, however, the same thing as reform.

The core problem is that social care, primary health, community health and the hospital service (not to mention social housing) all operate in separate parallel worlds. We rely on institutions which were designed to meet the needs of the 1950s with the clinical and management resources of the 1950s. At a time when most modern organisations have been restructured around IT systems that ensure information is collected once and passed efficiently to those best able to use it, our health and care system continues to be built on fragmented IT systems which are unable to communicate with each other.

Too often, failures of care arise, not because staff are not committed, or even because they are overloaded, but because the care system was not designed for the modern world; it is quite simply not fit for purpose. That is why reform is now urgently required. Not a reform of the management structure, but a reform of the way care is delivered.

The care model needs to reflect a world where the majority of care is not delivered in acute hospitals; it meets the less glamorous needs of increasingly dependent people who need help to allow them to enjoy maximum benefit from their longer lives. For these people, it makes little sense to distinguish healthcare from social care, and even less sense to distinguish between primary health and community health. Their need is for joined-up care that responds to their changing individual needs, and is able to avoid unnecessary acute episodes that cost money and undermine their quality of life. This was the thrust of the health select committee's report into social care earlier this year.

The good news (from a few trailblazers in the UK – but also from international experience) is that genuinely joined-up care can transform both costs (downwards) and quality (upwards). So real reform is possible – indeed I would argue it is unavoidable. But it is not the same thing as tinkering with funding structures. It requires a fundamental rethink of the way care is delivered. And time is running out.